Diabetic - Insulin Use
Insulin is an essential hormone. Without it, the body cannot control or properly use glucose (sugar) – one of its main energy supplying fuels
Who Needs To Use Insulin?
Type 1 diabetes and Type 2 diabetes differ in the following ways:
- Type I diabetes usually starts earlier in life and results from the pancreas not being able to make enough insulin. Therefore people with Type 1 diabetes must take insulin in order for their cells to be able to rake in blood glucose (sugar).
- Type 2 diabetes usually starts later in life and results from the cells not being able to use insulin efficiently. People with Type 2 diabetes can usually bring their blood sugar down by taking pills. However, after varying amounts of time (usually may years), a percentage of people with Type 2 diabetes will also need to use insulin as the pancreas eventually fails to make enough of the hormone to keep up with demands.
What Kinds of Insulin Are There?
There are four main kinds of injectable insulin. The type of insulin you use will depend on your individual needs and lifestyle.
- Short-acting insulin (Regular or R) starts to work in 30-40 minutest and lasts 6-8 hours in the body.
- Rapid-acting insulin (e.g. Humalog®. NovoRapid®) starts to work in 5-15 minutes and lasts for up to 4½ hours in the body.
- Intermediate-acting insulin (NPH or N and Lente or L) starts to work in 1-3 hours in the body.
- Long-acting insulin (Ultralente or U) starts to work in 4-6 hours and lasts for 24-28 hours in the body.
Many people use a combination of a rapid-acting or short-acting insulin for quick action (e.g. before meals) and an intermediate-acting or long-acting insulin to work throughout the day.
Once the person has found the right combination of insulin and does that work for them, they can reduce the number of doses they need to inject during the day by using premixed insulin. These mixtures most often consists of Regular (R) insulin + NPH (N) insulin and are listed as two numbers with the R dose listed first.
What is the Best Device?
The best device for administering insulin is the one that you are most comfortable with.
- Syringes are available in 30, 50, and 100 unit sizes. In general and for the sake of accuracy, you should use the syringe that is the size just above the dose you need to inject. For example if you use 40 units of insulin you should use 50-unit syringe.
- The needles or syringes today are much finer than they used to be. They also have special coatings on them so that injection is made as painless as possible.
- There are also short and long needles available. Talk with your doctor or diabetic educator about which would be most appropriated for you.
- Insulin Pumps
- An insulin pump is a microcomputer about the size of a pager that delivers insulin in very accurate amounts (within one-tenth of a unit). The insulin is delivered via a small needle inserted into the fatty tissue and left there. A thin tube called infusion set is connected to the needle at one end and to a syringe reservoir of insulin at the other. A background dose of insulin is delivered throughout the day and the user delivers a surge of insulin whenever food is eaten. It is important to check blood glucose 4-5 times a day when using an insulin pump.
- Pens and Jet Injectors
- Insulin pens are named for their size and shape. They are very convenient and portable. People who need to give themselves injections throughout the day especially find this method of administration convenient.
- The insulin cartridges that fit into the pens come in 1.5 mL (contains 150 units) or 3.0 mL (contains 300 units) sizes. The cartridge is inserted into the pen and remains there until all of the insulin is used. A short needle is attached to the end of the pen. It is important that you get instruction from a member of your diabetes healthcare team on proper use of pen.
How to Store Your Insulin?
You can keep the vial of insulin you are using at room temperature for 28 days after opening, but don’t let it get too hot or freeze.
Unopened insulin should be kept in the refrigerator. Always check the expiry date on your insulin before using it.
How to Inject Insulin
Insulin should be injected into the fatty part of the abdomen where it is absorbed most quickly and consistently. Don't inject insulin closer than 2 inches from your belly button.
Additional Options for injection include the:
- Upper arms
It is important to discuss a pattern of injections with your doctor or diabetes educator because insulin is absorbed from different parts of your body at different rates.
- When injection a needle, first choose the site for your injection and clean the skin with an alcohol swab.
- Pinch up a large area of skin and push the needle into the skin at a 90-degree angle. When using a very short needle (5 mm long), there is usually no need to pinch up the skin. People who are overweight may need longer needles. Discuss this with your doctor.
- Push the plunger all the way down. Release the pinched skin and pull the needle out. If insulin leaks out of the skin after removing the needle, try waiting for 5-10 seconds before removing the needle next time. Do not worry if a small drop of blood appears at the site
How can I keep my blood sugar level from getting too high or too low?
You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or his or her office staff can teach you how to use the monitor. You'll need to write down each measurement and show this record to your doctor. He or she will use this information to decide how much insulin is right for you.
- Never give yourself an injection without knowing what your blood sugar levels are first.
- Have some sweets on hand in case your blood sugar drops too low.
- Only use the recommended amount of insulin per your doctor
- Do not use dirty needles and do not reuse needles.
- Do not move the needle around while it is in your body, this could cause the needle to break and cause serious injury.
- Administer injections in different places each time to prevent severe scar tissue.
- Keep insulin stored in a cool place such as a refrigerator; do not allow it to freeze.
Hypoglycemia is the name for a condition in which the level of sugar in your blood is too low. If you use insulin, your blood sugar level can get too low if you exercise more than usual, if you don't eat enough, if you don't eat on time or if you take too much insulin. Most people who take insulin have insulin reactions at some time. Signs of an insulin reaction and hypoglycemia include the following:
- Losing muscle coordination
- Being unable to speak or think clearly
- Feeling very tired
- Becoming very pale
- Losing consciousness
How to deal with an Insulin reaction?
People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction.
The following are examples of quick sources of energy that can relieve the symptoms of an insulin reaction:
- Fruit juice: ½ cup (Orange Juice is the best)
- Glucagon comes in a kit with a powder and a liquid that must be mixed together and then injected. It will raise your blood sugar level. Talk to your doctor to learn when and how to use glucagon.
- Raisins 2 tablespoonful
- Glucose tablets: 3 tablets (5 grams each)
- Non diet soda: ½ to ¾ cup
If you don't feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.
*Dispose of the needle in a puncture-proof container (e.g. syringe disposal system)
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